MACRA and Value-Based Care

Module Description

The Centers for Medicare & Medicaid Services (CMS) sets payment policy at the federal level that impacts both Medicare and Medicaid coverage programs, which, together, serve over 147.5 million beneficiaries and influence payment models in the private health insurance market.  As both public and private payers get ready to implement payment reform authorized through the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA), our health system will need to adjust both clinical and financial models. This module provides a description of MACRA and a roadmap for how clinicians can lead their organizations to thrive in the new world of value-based care.

Intended Audience

This course is designed for physicians as well as nurse practitioners, physician assistants, and allied health professionals who are working toward population health management, especially in safety-net settings.

Duration and Fee

Estimated Time to Complete: 1 hour

Registration Fee: $20

CME Credits

This Enduring Material activity, Population Health in the Safety Net, has been reviewed and is acceptable for up to 12.00 Prescribed credit(s) by the American Academy of Family Physicians. AAFP certification begins 10/01/2018. Term of approval is for one year from this date. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Faculty

Dr. Jeanene Smith joined HMA in 2015 following 15 years of experience developing major health policy initiatives in Oregon. As the chief medical officer directing the health policy office for the Oregon Health Authority, she provided clinical guidance for agency and statewide efforts to implement and spread Oregon’s coordinated care model across the delivery system. Since joining HMA, she has focused on both state health policy and clinical delivery system reform. Dr. Smith has developed value-based payment approaches with states, providers and health systems, including template contract language for provider shared savings arrangements and working with a large provider group and hospital system on education and return on investment in value-based payment. She has been working alongside providers and their clinical staff in primary care clinics for the past two years as part of HMA’s team working with the State of Idaho to coach 165 clinics to adopt the primary care home model. Her experience in Oregon has been applied to projects for both behavioral health and oral health integration efforts to transform care delivery.In this module Dr. Smith draws on her deep understanding of federal and state health policy to discuss the implications of MACRA and demonstrate how clinical leaders can help their organizations prepare for value-based payments.

Dr. Jeanene Smith discloses that she is an employee of Health Management Associates, a national research and consulting firm providing technical assistance to a diverse group of healthcare clients.

Learning Objectives

At the completion of the course, attendees will be able to:

  • Describe how Medicare influences the delivery system and payment structure in the U.S., and the movement to value-based care payments.
  • List the basics of the Medicare Access and Children’s Health Insurance Program Reauthorization Act (MACRA) and its Quality Payment Program.
  • Compare and contrast the two paths to payment in MACRA: The Advanced Alternative Payment Model (AAPM) & The Merit-Based Incentive Payment System (MIPS).
  • Describe how clinician leaders can lead their groups towards practice transformation to be successful in MACRA.

Module Content